Epidemiology and Infection

Research Article

A community outbreak of haemolytic-uraemic syndrome in children occurring in a large area of Northern Italy over a period of several months

A. E. Tozzia1 c1, A. Niccolinia1, A. Capriolia2, I. Luzzia3, G. Montinia4, G. Zacchelloa4, A. Gianvitia5, F. Principatoa5 and G. Rizzonia5

a1 Laboratorio di Epdemiologia e Biostatistica, Istituto Superiors di Sanità, Rome

a2 Laboratorio di Ultrastrutture, Istituto Superiors di Sanità, Rome

a3 Laboratorio di Batteriologia e Micologia Medica, Istituto Superiors di Sanità, Rome

a4 Clinica Pediatrica, Università di Padova, Padua

a5 Divisione di Nefrologia e Dialixi. Ospedale Bambino Gesù, Rome, Italy


From March to October 1993. 15 cases of haemolytic-uraemic syndrome (HUS) in children were detected in a large area of northern Italy, where only 8 cases had occurred in the previous 5 years. Analysis of stool and serum specimens obtained from 14 cases showed evidence of Verotoxin-producing Escherichia coli (VTEC) infection in 13. Serum antibodies to the E. coli O157 lipopolysaccharide (LPS) were found in 8 patients and to the O111 LPS in 2. An O86 VTEC was isolated from another patient. Fourteen children needed dialysis, and 1 died. No obvious epidemiologic link was observed among cases, most of whom lived in small townships. A case-control study did not show an association between HUS and food or exposure to cattle, but suggested an association with contact with chicken coops (OR = 6·5. 95% C.I. 1·2–34·9). However, VTEC were not isolated from stool samples obtained from the chicken coops involved. The risk factors for VTEC infection related to living in rural settlements, including the exposure to live poultry, should be considered in outbreak investigations.

(Accepted May 24 1994)


c1 Correspondence and reprint requests to: Dr A. E. Tozzi, Istituto Superiore di Sanita. Laboratorio di Epidemiologia e Biostatistica. Viale Regina Elena. 299. 00161 ROMA. Italy.